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1.
BMC Infect Dis ; 20(1): 270, 2020 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-32264829

RESUMEN

BACKGROUND: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. CASE PRESENTATION: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. CONCLUSIONS: Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.


Asunto(s)
Bacteriemia/diagnóstico , Enfermedades Transmisibles/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Orientia tsutsugamushi/genética , Tifus por Ácaros/diagnóstico , Choque Séptico/diagnóstico , Anciano , Animales , Azitromicina/uso terapéutico , Bacteriemia/tratamiento farmacológico , Mordeduras y Picaduras , Enfermedades Transmisibles/tratamiento farmacológico , Exactitud de los Datos , Doxiciclina/uso terapéutico , Humanos , Masculino , Tifus por Ácaros/tratamiento farmacológico , Choque Séptico/tratamiento farmacológico , Resultado del Tratamiento , Trombiculidae/microbiología
5.
BMC Infect Dis ; 20(1): 222, 2020 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-32171261

RESUMEN

BACKGROUND: Infectious diarrhea can lead to a considerable global disease burden. Thus, the accurate prediction of an infectious diarrhea epidemic is crucial for public health authorities. This study was aimed at developing an optimal random forest (RF) model, considering meteorological factors used to predict an incidence of infectious diarrhea in Jiangsu Province, China. METHODS: An RF model was developed and compared with classical autoregressive integrated moving average (ARIMA)/X models. Morbidity and meteorological data from 2012 to 2016 were used to construct the models and the data from 2017 were used for testing. RESULTS: The RF model considered atmospheric pressure, precipitation, relative humidity, and their lagged terms, as well as 1-4 week lag morbidity and time variable as the predictors. Meanwhile, a univariate model ARIMA (1,0,1)(1,0,0)52 (AIC = - 575.92, BIC = - 558.14) and a multivariable model ARIMAX (1,0,1)(1,0,0)52 with 0-1 week lag precipitation (AIC = - 578.58, BIC = - 578.13) were developed as benchmarks. The RF model outperformed the ARIMA/X models with a mean absolute percentage error (MAPE) of approximately 20%. The performance of the ARIMAX model was comparable to that of the ARIMA model with a MAPE reaching approximately 30%. CONCLUSIONS: The RF model fitted the dynamic nature of an infectious diarrhea epidemic well and delivered an ideal prediction accuracy. It comprehensively combined the synchronous and lagged effects of meteorological factors; it also integrated the autocorrelation and seasonality of the morbidity. The RF model can be used to predict the epidemic level and has a high potential for practical implementation.


Asunto(s)
Diarrea/epidemiología , Diarrea/microbiología , Epidemias/prevención & control , Predicción/métodos , Modelos Estadísticos , Presión Atmosférica , China/epidemiología , Exactitud de los Datos , Humanos , Incidencia , Morbilidad , Estaciones del Año , Tiempo (Meteorología)
6.
PLoS One ; 15(3): e0223461, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32182246

RESUMEN

Monitoring of blood glucose is an invasive, painful and costly practice in diabetes. Consequently, the search for a more cost-effective (reagent-free), non-invasive and specific diabetes monitoring method is of great interest. Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy has been used in diagnosis of several diseases, however, applications in the monitoring of diabetic treatment are just beginning to emerge. Here, we used ATR-FTIR spectroscopy to evaluate saliva of non-diabetic (ND), diabetic (D) and insulin-treated diabetic (D+I) rats to identify potential salivary biomarkers related to glucose monitoring. The spectrum of saliva of ND, D and D+I rats displayed several unique vibrational modes and from these, two vibrational modes were pre-validated as potential diagnostic biomarkers by ROC curve analysis with significant correlation with glycemia. Compared to the ND and D+I rats, classification of D rats was achieved with a sensitivity of 100%, and an average specificity of 93.33% and 100% using bands 1452 cm-1 and 836 cm-1, respectively. Moreover, 1452 cm-1 and 836 cm-1 spectral bands proved to be robust spectral biomarkers and highly correlated with glycemia (R2 of 0.801 and 0.788, P < 0.01, respectively). Both PCA-LDA and HCA classifications achieved an accuracy of 95.2%. Spectral salivary biomarkers discovered using univariate and multivariate analysis may provide a novel robust alternative for diabetes monitoring using a non-invasive and green technology.


Asunto(s)
Diabetes Mellitus Experimental/tratamiento farmacológico , Glucosa/análisis , Insulinas/uso terapéutico , Monitoreo Fisiológico/métodos , Saliva/química , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Animales , Biomarcadores , Análisis Costo-Beneficio , Exactitud de los Datos , Diabetes Mellitus Experimental/inducido químicamente , Análisis Discriminante , Masculino , Análisis de Componente Principal , Curva ROC , Ratas , Ratas Wistar , Sensibilidad y Especificidad , Estreptozocina/farmacología
7.
PLoS One ; 15(3): e0222738, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32182249

RESUMEN

Chronic pulmonary aspergillosis (CPA) is a slow and progressive disease that develops in preexisting lung cavities of patients with tuberculosis sequelae, and it is associated with a high mortality rate. Serological tests such as double agar gel immunodiffusion test (DID) or counterimmunoelectrophoresis (CIE) test have been routinely used for CPA diagnosis in the absence of positive cultures. However, these tests have been replaced with enzyme-linked immunoassay (ELISA) and, a variety of methods. This systematic review compares ELISA accuracy to reference test (DID and/or CIE) accuracy in CPA diagnosis. It was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study was registered in PROSPERO under the registration number CRD42016046057. We searched the electronic databases MEDLINE (PubMed), EMBASE (Elsevier), LILACS (VHL), Cochrane library, and ISI Web of Science. Gray literature was researched using Google Scholar and conference abstracts. We included articles with patients or serum samples from patients with CPA who underwent two serological tests: ELISA (index test) and IDD and/or CIE (reference test). We used the test accuracy as a result. Original articles were considered without a restriction of date or language. The pooled sensitivity, specificity, and summary receiver operating characteristic curves were estimated. We included 14 studies in the review, but only four were included in the meta-analysis. The pooled sensitivities and specificities were 0.93 and 0.97 for the ELISA test. These values were 0.64 and 0.99 for the reference test (DID and/or CIE). Analyses of summary receiver operating characteristic curves yielded 0.99 for ELISA and 0.99 for the reference test (DID and/or CIE). Our meta-analysis suggests that the diagnostic accuracy of ELISA is greater than the reference tests (DID and/or CIE) for early CPA detection.


Asunto(s)
Aspergillus/inmunología , Exactitud de los Datos , Aspergilosis Pulmonar/diagnóstico , Pruebas Serológicas/normas , Enfermedad Crónica , Contrainmunoelectroforesis/métodos , Electroforesis en Gel de Agar/métodos , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Aspergilosis Pulmonar/microbiología , Curva ROC , Sensibilidad y Especificidad
8.
BMC Infect Dis ; 20(1): 242, 2020 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-32209054

RESUMEN

BACKGROUND: Tuberculous pleurisy (TBP) is the most common form of extrapulmonary tuberculosis (TB). However, rapid diagnostic methods with high accuracy for tuberculous pleurisy are urgently needed. In the present study, we evaluated the diagnostic accuracy of Xpert MTB/RIF, LAMP and SAT-TB assay with pleural fluids from culture-positive TBP patients. METHODS: We prospectively enrolled 300 patients with exudative pleural effusions used as the samples for Xpert MTB/RIF, LAMP and SAT-TB assay. Of these, 265 including 223 patients diagnosed with TBP and 42 non-TBP patients used as controls were analyzed. RESULTS: The sensitivities of Xpert MTB/RIF (27.4%), LAMP (26.5%) and SAT-TB assay (32.3%) were significantly higher than that of pleural effusion smear (14.3%, X2 = 20.65, P <  0.001), whereas they were much lower than expected for the analysis of pleural effusion samples. Both SAT-TB assay and Xpert MTB/RIF demonstrated high specificities (100%) and PPVs (100%), but the NPVs of all of the tests were < 22%. The area under ROC curve of pleural effusion smear, LAMP, Xpert MTB/RIF and SAT-TB assays was 0.524 (95% CI 0.431-0.617), 0.632 (95% CI 0.553-0.71), 0.637 (95% CI 0.56-0.714) and 0.673 (95% CI 0.6-0.745). SAT-TB assays had the highest AUC. CONCLUSION: Nucleic acid amplification tests are not the first choice in the diagnosis of tuberculous pleurisy. In this type of test, SAT-TB is recommended because of its low cost, relatively more accurate compared with the other two tests. This prospective study was approved by The Ethics Committee of the Shanghai Pulmonary Hospital (approval number: K19-148). TRIAL REGISTRATION: ClinicalTrials.gov identifier: ChiCTR1900026234 (Retrospectively registered). The registration date is September 28, 2019.


Asunto(s)
Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico/métodos , Tuberculosis Pleural/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , China , ADN Bacteriano/genética , Exactitud de los Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico/economía , Derrame Pleural/microbiología , Estudios Prospectivos , ARN Bacteriano/genética , Curva ROC , Sensibilidad y Especificidad , Tuberculosis Pleural/microbiología , Adulto Joven
9.
Am Surg ; 86(2): 83-89, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167053

RESUMEN

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.


Asunto(s)
Urgencias Médicas , Medición de Riesgo/métodos , Procedimientos Quirúrgicos Operativos/mortalidad , Exactitud de los Datos , Humanos , Tiempo de Internación , Modelos Logísticos , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Infecciones Urinarias/mortalidad , Heridas y Traumatismos/clasificación , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/cirugía
11.
PLoS One ; 15(2): e0220419, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053586

RESUMEN

Across a broad spectrum of memory tasks, retention is superior following a night of sleep compared to a day of wake. However, this result alone does not clarify whether sleep merely slows the forgetting that would otherwise occur as a result of information processing during wakefulness, or whether sleep actually consolidates memories, protecting them from subsequent retroactive interference. Two influential studies suggested that sleep protects memories against the subsequent retroactive interference that occurs when participants learn new yet overlapping information (interference learning). In these studies, interference learning was much less detrimental to memory following a night of sleep compared to a day of wakefulness, an indication that sleep supports this important aspect of memory consolidation. In the current replication study, we repeated the protocol of and, additionally, we examined the impact of intrinsic motivation on performance in sleep and wake participants. We were unable to replicate the finding that sleep protects memories against retroactive interference, with the detrimental effects of interference learning being essentially the same in wake and sleep participants. We also found that while intrinsic motivation benefitted task acquisition it was not a modulator of sleep-wake differences in memory processing. Although we cannot accept the null hypothesis that sleep has no role to play in reducing the negative impact of interference, the findings draw into question prior evidence for sleep's role in protecting memories against interference. Moreover, the current study highlights the importance of replicating key findings in the study of sleep's impact on memory processing before drawing strong conclusions that set the direction of future research.


Asunto(s)
Exactitud de los Datos , Consolidación de la Memoria/fisiología , Recuerdo Mental/fisiología , Sueño/fisiología , Vigilia/fisiología , Adolescente , Adulto , Femenino , Humanos , Masculino , Pruebas de Memoria y Aprendizaje , Motivación/fisiología , Reproducibilidad de los Resultados , Adulto Joven
12.
PLoS One ; 15(2): e0228434, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027668

RESUMEN

The service quality and system dependability of real-time communication networks strongly depends on the analysis of monitored data, to identify concrete problems and their causes. Many of these can be described by either their structural or temporal properties, or a combination of both. As current research is short of approaches sufficiently addressing both properties simultaneously, we propose a new feature space specifically suited for this task, which we analyze for its theoretical properties and its practical relevance. We evaluate its classification performance when used on real-world data sets of structural-temporal mobile communication data, and compare it to the performance achieved of feature representations used in related work. For this purpose we propose a system which allows the automatic detection and prediction of classes of pre-defined sequence behavior, greatly reducing costs caused by the otherwise required manual analysis. With our proposed feature spaces this system achieves a precision of more than 93% at recall values of 100%, with an up to 6.7% higher effective recall than otherwise similarly performing alternatives, notably outperforming alternative deep learning, kernel learning and ensemble learning approaches of related work. Furthermore the supported system calibration allows separating reliable from unreliable predictions more effectively, which is highly relevant for any practical application.


Asunto(s)
Comunicación , Aprendizaje Profundo , Aprendizaje Automático , Redes Neurales de la Computación , Sistemas de Computación/normas , Exactitud de los Datos , Minería de Datos/métodos , Minería de Datos/normas , Conjuntos de Datos como Asunto/normas , Humanos , Aplicaciones Móviles/normas , Aplicaciones Móviles/estadística & datos numéricos , Reproducibilidad de los Resultados , Factores de Tiempo , Estudios de Validación como Asunto
13.
BMC Bioinformatics ; 21(1): 65, 2020 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-32085702

RESUMEN

BACKGROUND: ChIP (Chromatin immunoprecipitation)-exo has emerged as an important and versatile improvement over conventional ChIP-seq as it reduces the level of noise, maps the transcription factor (TF) binding location in a very precise manner, upto single base-pair resolution, and enables binding mode prediction. Availability of numerous peak-callers for analyzing ChIP-exo reads has motivated the need to assess their performance and report which tool executes reasonably well for the task. RESULTS: This study has focussed on comparing peak-callers that report direct binding events with those that report indirect binding events. The effect of strandedness of reads and duplication of data on the performance of peak-callers has been investigated. The number of peaks reported by each peak-caller is compared followed by a comparison of the annotated motifs present in the reported peaks. The significance of peaks is assessed based on the presence of a motif in top peaks. Indirect binding tools have been compared on the basis of their ability to identify annotated motifs and predict mode of protein-DNA interaction. CONCLUSION: By studying the output of the peak-callers investigated in this study, it is concluded that the tools that use self-learning algorithms, i.e. the tools that estimate all the essential parameters from the aligned reads, perform better than the algorithms which require formation of peak-pairs. The latest tools that account for indirect binding of TFs appear to be an upgrade over the available tools, as they are able to reveal valuable information about the mode of binding in addition to direct binding. Furthermore, the quality of ChIP-exo reads have important consequences on the output of data analysis.


Asunto(s)
Secuenciación de Inmunoprecipitación de Cromatina/métodos , Factores de Transcripción/metabolismo , Algoritmos , Sitios de Unión , Exactitud de los Datos , Humanos
14.
PLoS One ; 15(2): e0225019, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32097413

RESUMEN

Small animal imaging has become essential in evaluating new cancer therapies as they are translated from the preclinical to clinical domain. However, preclinical imaging faces unique challenges that emphasize the gap between mouse and man. One example is the difference in breathing patterns and breath-holding ability, which can dramatically affect tumor burden assessment in lung tissue. As part of a co-clinical trial studying immunotherapy and radiotherapy in sarcomas, we are using micro-CT of the lungs to detect and measure metastases as a metric of disease progression. To effectively utilize metastatic disease detection as a metric of progression, we have addressed the impact of respiratory gating during micro-CT acquisition on improving lung tumor detection and volume quantitation. Accuracy and precision of lung tumor measurements with and without respiratory gating were studied by performing experiments with in vivo images, simulations, and a pocket phantom. When performing test-retest studies in vivo, the variance in volume calculations was 5.9% in gated images and 15.8% in non-gated images, compared to 2.9% in post-mortem images. Sensitivity of detection was examined in images with simulated tumors, demonstrating that reliable sensitivity (true positive rate (TPR) ≥ 90%) was achievable down to 1.0 mm3 lesions with respiratory gating, but was limited to ≥ 8.0 mm3 in non-gated images. Finally, a clinically-inspired "pocket phantom" was used during in vivo mouse scanning to aid in refining and assessing the gating protocols. Application of respiratory gating techniques reduced variance of repeated volume measurements and significantly improved the accuracy of tumor volume quantitation in vivo.


Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Técnicas de Imagen Sincronizada Respiratorias/métodos , Microtomografía por Rayos X/métodos , Animales , Exactitud de los Datos , Modelos Animales de Enfermedad , Mediciones del Volumen Pulmonar , Ratones , Ratones Endogámicos C57BL , Ratones Transgénicos , Fantasmas de Imagen , Sensibilidad y Especificidad , Microtomografía por Rayos X/instrumentación
15.
BMC Infect Dis ; 20(1): 85, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-32000694

RESUMEN

BACKGROUND: Little is known about the potential use of the eosinophil count as a predictive marker of bloodstream infection. In this study, we aimed to assess the reliability of eosinopenia as a predictive marker of bloodstream infection. METHODS: This retrospective cohort study was performed in the outpatient department and general internal medicine department of a tertiary university hospital in Japan. A total of 189 adult patients with at least 2 sets of blood cultures obtained during the period January 1-December 31, 2018, were included; those with the use of antibiotic therapy within 2 weeks prior to blood culture, steroid therapy, or a history of haematological cancer were excluded. The diagnostic accuracies of each univariate variable and the multivariable logistic regression models were assessed by calculating the areas under the receiver operating characteristic curves (AUROCs). The primary outcome was a positive blood culture indicating bloodstream infection. RESULTS: Severe eosinopenia (< 24.4 cells/mm3) alone yielded small but statistically significant overall predictive ability (AUROC: 0.648, 95% confidence interval (CI): 0.547-0.748, P < 0.05), and only moderate sensitivity (68, 95% CI: 46-85%) and specificity (62, 95% CI: 54-69%). The model comprising baseline variables (age, sex), the C-reactive protein level, and neutrophil count yielded an AUROC of 0.729, and further addition of eosinopenia yielded a slight improvement, with an AUROC of 0.758 (P < 0.05) and a statistically significant net reclassification improvement (NRI) (P = 0.003). However, the integrated discrimination index (IDI) (P = 0.284) remained non-significant. CONCLUSIONS: Severe eosinopenia can be considered an inexpensive marker of bloodstream infection, although of limited diagnostic accuracy, in a general internal medicine setting.


Asunto(s)
Agranulocitosis , Bacteriemia/sangre , Bacteriemia/diagnóstico , Eosinófilos/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Exactitud de los Datos , Femenino , Hospitales Universitarios , Humanos , Japón , Recuento de Leucocitos/métodos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neutrófilos/metabolismo , Estudios Retrospectivos , Sensibilidad y Especificidad
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(1): 85-89, 2020 Jan 10.
Artículo en Chino | MEDLINE | ID: mdl-32062948

RESUMEN

Objective: To assess the quality of data of intervention in population at high risk for HIV/AIDS, especially in female sex workers (FSWs) and men who have sex with men (MSM), in China during 2014-2018, for the purpose of improving intervention data quality. Methods: Data accuracy was evaluated by sampling monthly reported intervention data and comparing the consistency of the information recorded in national HIV/AIDS prevention and treatment information system to original paper records. Data authenticity was assessed by visiting intervention sites and interviewing owners, manager and/or target groups at sites. The assessment results of both national level and provincial level were summarized by year and analyzed with descriptive statistical method. The data quality problems recognized by assessments were summed up. Results: The annual concordance rate of the data recorded in information system to paper records was 94.6%(17 671/18 673) in provincial level assessment and 79.4%(558/703) in national level assessment. Up to 81.6%(8 617/10 559) and 84.4% (249/295) of all sampled intervention sites were annually evaluated as "good" in provincial and state level assessments respectively. The assessment found that the intervention data in original paper records were not completely consistent to that recorded in the information system, the deficiency of ability on intervention data management, and the insufficient coverage and effect of intervention service influenced the intervention data quality. Conclusions: In general, the accuracy and authenticity of intervention data were fine in China during 2014-2018. Intervention data quality can be improved through measures of enhancing data quality management, strengthening training for the prevention and intervention in FSWs and MSM, and providing high- quality intervention service.


Asunto(s)
Exactitud de los Datos , Infecciones por VIH , Minorías Sexuales y de Género , China , Femenino , VIH , Infecciones por VIH/prevención & control , Infecciones por VIH/terapia , Homosexualidad Masculina , Humanos , Masculino , Trabajadores Sexuales
17.
BMC Health Serv Res ; 20(1): 35, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931793

RESUMEN

BACKGROUND: Over the past decade, influenza surveillance has been established in several African countries including Zambia. However, information on the on data quality and reliability of established influenza surveillance systems in Africa are limited. Such information would enable countries to assess the performance of their surveillance systems, identify shortfalls for improvement and provide evidence of data reliability for policy making and public health interventions. METHODS: We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza surveillance system (ISS) in Zambia during 2011-2017 using 9 attributes: (i) data quality and completeness, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability, (viii) utility, and (ix) sustainability. Each attribute was evaluated using pre-defined indicators. For each indicator we obtained the proportion (expressed as percentage) of the outcome of interest over the total. A scale from 1 to 3 was used to provide a score for each attribute as follows: < 60% (as obtained in the calculation above) scored 1 (weak performance); 60-79% scored 2 (moderate performance); ≥80% scored 3 (good performance). An overall score for each attribute and the ISS was obtained by averaging the scores of all evaluated attributes. RESULTS: The overall mean score for the ISS in Zambia was 2.6. Key strengths of the system were the quality of data generated (score: 2.9), its flexibility (score: 3.0) especially to monitor viral pathogens other than influenza viruses, its simplicity (score: 2.8), acceptability (score: 3.0) and stability (score: 2.6) over the review period and its relatively low cost ($310,000 per annum). Identified weaknesses related mainly to geographic representativeness (score: 2.0), timeliness (score: 2.5), especially in shipment of samples from remote sites, and sustainability (score: 1.0) in the absence of external funds. CONCLUSIONS: The system performed moderately well in our evaluation. Key improvements would include improvements in the timeliness of samples shipments and geographical coverage. However, these improvements would result in increased cost and logistical complexity. The ISSS in Zambia is largely reliant on external funds and the acceptability of maintaining the surveillance system through national funds would require evaluation.


Asunto(s)
Gripe Humana/epidemiología , Vigilancia de Guardia , Exactitud de los Datos , Humanos , Reproducibilidad de los Resultados , Zambia/epidemiología
18.
Hist Philos Life Sci ; 42(1): 5, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31925568

RESUMEN

The advancement of computing technology makes it possible to build extremely accurate digital reconstructions of brain circuits. Are such unprecedented levels of biological accuracy essential for brain simulations to play the roles they are expected to play in neuroscientific research? The main goal of this paper is to clarify this question by distinguishing between various roles played by large-scale simulations in contemporary neuroscience, and by reflecting about what makes a simulation biologically accurate. It is argued that large-scale simulations may play model-oriented and prediction-oriented roles in brain research, and that the concept of biological accuracy can be interpreted as related to the plausibility of the theoretical model implemented in the simulation system, to the accuracy of the computer implementation, and to the level of details of the implemented model. Building on these observations and distinctions, it is argued that biological accuracy is not essential for a computer simulation to play the epistemic roles it is expected to play in brain research.


Asunto(s)
Encéfalo/fisiología , Simulación por Computador , Exactitud de los Datos , Neurociencias/métodos
19.
Dis Colon Rectum ; 63(2): 226-232, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31914115

RESUMEN

BACKGROUND: Online physician rating Web sites are used by over half of consumers to select doctors. No studies have examined physician rating Web sites for colon and rectal surgeons. OBJECTIVE: The purpose of this study was to evaluate the accuracy and rating patterns of colon and rectal surgeons on the largest physician rating Web site. DESIGN: Physician characteristics and ratings were collected from a randomly selected sample of 500 from 3043 Healthgrades "colon and rectal surgery specialists." Board certifications were verified with the American Board of Surgery and American Board of Colon and Rectal Surgery Web sites. SETTINGS: Data acquisition was completed on July 18, 2018. PATIENTS: Patients were not directly studied. MAIN OUTCOME MEASURES: The primary outcome was to assess the accuracy of Healthgrades in reporting American Board of Surgery and American Board of Colon and Rectal Surgery certification. The secondary outcome was to identify factors associated with high star ratings. RESULTS: A total of 48 (9.6%) of the 500 sampled were incorrectly identified as practicing US surgeons and excluded from subsequent analysis. Healthgrades showed 80.1% agreement with verified board certifications for American Board of Surgery and 85.4% for American Board of Colon and Rectal Surgery. The mean star rating was 4.2 of 5.0 (SD = 0.9), and 77 (21.6%) had 5-star ratings. In a multivariable logistic model (p < 0.001), 5-star rating was associated with 1 to 9 years (OR = 2.76; p = 0.04) or >40 years in practice (OR = 3.35; p = 0.04) and fewer reviews (OR = 0.88; p < 0.001). There were no significant associations with surgeon sex, age, geographic region, or board certification. LIMITATIONS: Data were limited to a single physician rating Web site. CONCLUSIONS: In the modern age of healthcare consumerism, physician rating Web sites should be used with caution given inaccuracies. More accurate online resources are needed to inform patient decisions in the selection of specialized colon and rectal surgical care. See Video Abstract at http://links.lww.com/DCR/B91. PRECISIÓN DE DATOS Y PREDICTORES DE ALTAS CALIFICACIONES DE CIRUJANOS DE COLON Y RECTO EN UN SITIO WEB DE CALIFICACIÓN MÉDICA EN LÍNEA: Más de la mitad de los consumidores utilizan los sitios web de calificación de médicos en línea para seleccionar médicos. Ningún estudio ha examinado los sitios web de calificación de médicos para cirujanos de colon y recto.Evaluar la precisión y los patrones de calificación de los cirujanos de colon y recto en el sitio web más grande de calificación de médicos.Las características y calificaciones de los médicos se obtuvieron de una muestra seleccionada al azar de 500 de 3,043 "especialistas en cirugía de colon y recto" de Healthgrades. Las certificaciones del Consejo se verificaron en los sitios web del Consejo Americano de Cirugía y del Consejo Americano de Cirugía de Colon y Recto.La adquisición de datos se completó el 18 de julio de 2018.Los pacientes no fueron estudiados directamente.El resultado primario fue evaluar la precisión de Healthgrades al informar la certificación por el Consejo Americano de Cirugía y por el Consejo Americano de Cirugía de Colon y Recto. El resultado secundario fue identificar factores asociados con altas calificaciones en estrellas.Un total de 48 (9.6%) de la muestra de 500 fueron identificados incorrectamente como cirujanos practicantes de EE. UU. y excluidos del análisis subsecuente. Healthgrades mostró un 80.1% de concordancia con las certificaciones verificadas del Consejo Americano de Cirugía y el 85.4% con el Consejo Americano de Cirugía de Colon y Recto. La calificación promedio de estrellas fue 4.2 / 5 (SD 0.9), y 77 (21.6%) tuvieron calificaciones de 5 estrellas. En un modelo logístico multivariable (p <0.001), la calificación de 5 estrellas se asoció con 1-9 años (OR 2.76, p = 0.04) o más de 40 años en la práctica (OR 3.35, p = 0.04) y menos evaluaciones (OR 0.88, p <0.001). No hubo asociaciones significativas con el género, edad, región geográfica o certificación por los Consejos del cirujano.Los datos se limitaron a un solo sitio web de calificación de médicos.En la era moderna del consumismo en atención médica, los sitios web de calificación de los médicos deben usarse con precaución debido a imprecisiones. Se necesitan recursos en línea más precisos para que las decisiones de los pacientes sean informadas en la selección de atención quirúrgica especializada de colon y recto. Consulte Video Resumen en http://links.lww.com/DCR/B91. (Traducción-Dr. Jorge Silva-Velazco).


Asunto(s)
Colon/cirugía , Sistemas en Línea/instrumentación , Recto/cirugía , Cirujanos/estadística & datos numéricos , Exactitud de los Datos , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Valor Predictivo de las Pruebas , Consejos de Especialidades/organización & administración , Cirujanos/organización & administración
20.
BMC Infect Dis ; 20(1): 33, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931736

RESUMEN

BACKGROUND: The WHO recently recommended the new Xpert MTB/RIF Ultra assay (Ultra) instead of the Xpert MTB/RIF assay because Ultra has improved sensitivity. We report the diagnostic accuracy of Ultra for tuberculous adenitis in a tuberculosis and HIV endemic setting. METHODS: We obtained fine-needle aspirates (FNA) and lymph node tissue by core-needle biopsy in adult patients with peripheral lymphadenopathy of >20 mm. Ultra and mycobacterial culture were performed on FNA and tissue specimens, with histological examination of tissue specimens. We assessed the diagnostic accuracy of Ultra against a composite reference standard of 'definite tuberculosis' (microbiological criteria) or 'probable tuberculosis' (histological and clinical criteria). RESULTS: We prospectively evaluated 99 participants of whom 50 were HIV positive: 21 had 'definite tuberculosis', 15 'probable tuberculosis' and 63 did not have tuberculosis (of whom 38% had lymphoma and 19% disseminated malignancy). Using the composite reference standard the Ultra sensitivity on FNA was 70% (95% CI 51-85; 21 of 30), and on tissue was 67% (45-84; 16/24) these were far superior to the detection of acid-fast bacilli on an FNA (26%; 7/27); AFB on tissue (33%; 8/24); or tissue culture (39%; 9/23). The detection of granulomas on histology had high senstivity (83%) but the lowest specficity. When compared with culture the Ultra on FNA had a sensitvity of 78% (40-97; 7/9) and tissue 90% (55-100; 9/10). CONCLUSIONS: Ultra performed on FNA or tissue of a lymph node had good sensitivity and high specificity. Ultra had a higher yield than culture and has the advantage of being a rapid test. Ultra on FNA would be an appropriate initial investigation for lymphadenopathy in tuberculosis endemic areas followed by a core biopsy for histopathology with a repeat Ultra on tissue if granulomas are present.


Asunto(s)
Exactitud de los Datos , Pruebas Diagnósticas de Rutina/métodos , Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico/métodos , Técnicas de Amplificación de Ácido Nucleico/normas , Tuberculosis Ganglionar/diagnóstico , Adulto , Biopsia con Aguja Fina , Femenino , VIH/inmunología , Seropositividad para VIH/virología , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Probabilidad , Estudios Prospectivos , Sensibilidad y Especificidad , Tuberculosis Ganglionar/patología
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